How to set up a telemedicine practice

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As more hospitals move from fee-for-service to value-based payment models that reward providers for keeping costs low, telemedicine offers a valuable tool for achieving that goal. Smartphones are everywhere, internet connections are faster and consumers are eager to engage with doctors on their own time from the convenience of their home or office. According to the American Telemedicine Association, more than 15 million Americans receive some kind of remote medical care, and that number was expected to grow by 30% in 2016.

Health systems are also primed to offer telemedicine services. Expanded access to primary and specialty providers, reduced emergency room visits and inpatient hospitalizations, and improved care coordination among a patient’s providers are some of the benefits telemedicine can provide.

Telehealth technology company American Well already has more than 50 health system partnerships. Among those that sealed the deal last year were New York Presbyterian, Bon Secours, and Baptist Health South Florida.

However, setting up a successful telemedicine practice requires serious planning and fitting a lot of disparate pieces into the healthcare puzzle. The SAMHSA-HRSA Center for Integrated Health Solutions developed a resource guide on starting and sustaining a telemedicine practice. Topics covered include what services to provide, billing and reimbursement, and policy guidelines and considerations.

Sarah Sossong, director of the Center for Telehealth at Massachusetts General Hospital, offers seven useful steps in planning and setting up a telemedicine practice.

Identify the site of care (outpatient, inpatient, ER, etc.), pain points and goals for the telemedicine practice.

Establish a structure to support the practice.

Take time to ramp up each specialty regarding operations, legal and regulatory issues and the technological aspects of the practice — software and hardware, training and systems integration.

Determine how telehealth practitioners will get paid. Will it be through some sort of grant funding? Institutional reimbursement? Patient self-pay? Contract? Or public and private payers?

Align to the regulatory and reimbursement environment (licensure, credentialing, practice standards, etc.) in the state or states the organization serves.

Another thing organizations need to consider is whether they should go it alone or partner with an established telemedicine company. Hospitals with limited resources to commit to telehealth and a short timeline to get the practice up and running may see a partnership as a way to address those issues. Vendor demonstrations and partnerships can also help an organization better refine what they are interested in achieving through a telehealth practice, Sossong says.

If a hospital does decide to partner, they should consider the capabilities of the different vendors carefully, she adds. “Partnerships don’t minimize the need for an internal dedicated lead, or team, but they can definitely help you achieve your goal more quickly, though at a cost. The cost of building internal infrastructure can also be significant depending upon your goal,” she says.

Despite enthusiasm for telemedicine, there are some concerns. Telehealth is governed by a patchwork of state regulations, which can be hard to sort out. Interoperability of electronic health records and questions about privacy and security are other potential concerns.

Some physicians may not be comfortable conducting a virtual patient exam, making a diagnosis or presenting a treatment plan without a face-to-face visit. The Texas Medical Board recently began requiring that physicians meet with patients in person prior to providing telemedicine services, which prompted telemedicine company Teladoc to file a lawsuit challenging the rule. This could limit when and how the services are used.

There are also technological costs and challenges. Telehealth services require special software, which in turn require training and support. If either the software or hardware fails during a doctor-patient encounter, the session ends without resolving the health issue that prompted it.

“While there are pros and cons to providing a telemedicine service, I don’t think it’s something that healthcare providers will long have a choice about,” Sossong tells Healthcare Dive. “Telemedicine services are becoming an expectation of consumers. In the same way that I expect that my bank will allow me to deposit checks via a mobile app without going into a brink and mortar facility, consumers will expect that appropriate telemedicine services will be provided by their healthcare provider, and paid for via insurance in the same way that appropriate face-to-face services are paid for.”

What kind of return on investment can organizations expect from a telehealth practice? “The ROI to be achieved depends upon your strategy, you solution and your goals,” Sossong says. Aligned with a population health management strategy, ROI could be improved patient engagement, patient outcomes and/or access to care. It could also be reduced costs via fewer readmissions or emergency room visits.